First four patients receive “single-port” LRP at Cleveland Clinic

Not to be outdone by all the recent new gizmos associated with radiotherapy, the surgical community is working hard to improve apparent outcomes to radical prostatectomy.

Kaouk et al. have reported data from the first four patients to receive a single-port laparoscopic prostatectomy at the Cleveland Clinic. Traditionally, LRP has been performed using five separate “ports” through which the surgeon and his assistant operate and visualize the procedure. We should be clear that the new process reported by Kaouk and his colleagues is not (yet) a robot-assisted procedure.

All patients were operated on through a single umbilical incision using a three-channel port and specially designed, flexible laparoscopic instrumentation. Four procedures have been completed since November 26, 2007. The patients all had early-stage prostate cancer (clinical stage T1c), no previous pelvic surgery, and a body mass index ≤ 35 kg/m2.

A multichannel port was inserted transperitoneally through a 1.8-cm umbilical incision. No additional extraumbilical instruments or ports were inserted. Urethrovesical anastomosis was performed using free-hand interrupted suturing and extracorporeal knot tying. Data were collected prospectively into the Cleveland Clinic’s institutional review board-approved data registry.

The authors report that all cases were completed successfully, without conversion to a standard laparoscopic approach. Specifically:

  • The total operative time was 285 ± 30 minutes, with a mean operative time for prostate excision and urethrovesical anastomosis of 3.25 hours and 1.1 hours, respectively.
  • The mean blood loss was 288 ± 131 ml, and no patient required a blood transfusion.
  • The hospital stay was 2.5 ± 0.6 days.
  • The Foley catheter was removed 2 weeks (range 1-3 weeks) after surgery.
  • No intraoperative complications occurred; however, 1 patient developed a rectourethral fistula that was noted 2 months after surgery.
  • At 18 weeks of follow-up, 3 patients used 1 or 0 pads for continence daily, 2 patients had positive margins noted at the site of extracapsular extension, and all patients had an undetectable PSA level.

The authors conclude that single-port LRP is feasible. However, they add that additional investigation is needed to evaluate the safety and oncologic adequacy of this new approach.

One Response

  1. For a perspective about minimally invasive surgical technology please view the 15-minute There is a Lot of Hype Out There video.

    The talk was presented in November 2007. It was then that single-port prostatectomy first emerged. It is briefly mentioned at the end of this 15 minute video presentation.

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